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題名 | Unusual Dental Injuries Following Facial Fractures: Report of Three Cases=顏面外傷後併發罕見的牙齒傷害:三例報告 |
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作者 | 蔡宗儒; 洪至正; 張松源; 董東瓚; 陳國鼎; | 書刊名 | 長庚醫學 |
卷期 | 21:4 1998.12[民87.12] |
頁次 | 頁475-480 |
分類號 | 416.956 |
關鍵詞 | 牙齒缺失; 顏面外傷; 上顎竇; 鼻腔; 腸胃道; Missing tooth; Facial trauma; Maxillary sinus; Nasal cavity; Alimentary tract; |
語文 | 英文(English) |
中文摘要 | 牙齒傷朗是顏面外傷後敘見的併發症之一,根據文獻記錄,平均發生率在16%到 32%之間,以下顎骨骨折患者為多見,根據Silvennoinen一篇356個下顎骨骨折的病例研究 報告,雙側下顎骨顆(condyle)骨折是併發嚴重牙齒傷害的最重要的相關因素,外科醫師 在評估及治療這樣的病人時,最常遇到的問題就是齒列咬合嚴重破壞,使得顏面骨折的治療 困難度增高。有時因為傷害嚴重而出現生命危險的情況,如中樞神經傷害(neurosurgical injuries),出血性休克(hemorrhagic shock)等,牙齒的治療常被延遲或忽略,最終造 成牙齒的損壞或是其它的併發症。 顏面骨折後常併發的牙齒傷害有牙齒斷裂(fracture),鬆動(lunation),移位( displacement),及脫落(avulsion),牙齒內陷(intrusion)是牙齒移位的一種,常見 於兒童未成熟的牙床,又以上顎門牙處最多見;牙齒完全內陷(full intrusion)是非常罕 見的一種牙齒傷害,它是因牙齒直接受垂直的外力撞擊或下顎骨受外力撞擊後上下牙齒強力 閉合時引起的。過去很少有病例報告討論此類罕見的傷害,本篇報告共提出兩例顏面骨折患 者併發牙齒完全內陷的案例;另外,也報告一少見的案例,多處牙齒斷落,意外掉入腸胃道 內,除了說明我們的治療經驗,也根據文獻,提出一些處理牙齒傷害的基本方法。我們強調 ,在顏面骨折外傷的病人,同時發生牙齒傷害是常見的,迅速正確的診斷非常重要,根本治 療需要即時照會牙科醫師,但是外科醫師應該給予適當的處理可以大幅改善預後,而且可以 避免併發症。 |
英文摘要 | We report 3 cases of unusual dental injuries following facial fractures. The first patient sustained intrusion of a maxillary incisor into the nasal cavity following a mandibular fracture. The tooth dislocated into the pharynx and was found lodged in the piriform fossa during surgery. The second patient sustained intrusion of molars into the maxillary sinus following maxillary and mandibular fractures. His treatment was delayed due to life-threatening hemorrhage. The third case involved ingestion of multiple avulsed teeth into the alimentary tract following severe maxillofacial fractures. Although the diagnosis was made more than a week after the injury, the patient did not suffer any complications as a result of the dental avulsion. The aim of this report is to emphasize the possibility of associated dental injuries in patients with facial fractures. The trauma surgeon should be cognizant of the importance of carrying out a thorough intraoral examination during the initial evaluation. Any missing tooth should be considered as possibly displaced into other tissue compartments, and must be routinely searched for with x-rays of the skull, cervical spine, chest, and abdomen. If full intrusion injury is suspected, further diagnostic investigation with facial computed tomography scanning may be worthwhile. |
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